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A Brief History of Medical Cannabis
It is hypothesized that cannabis originated from the northeastern Hindu Mountains of Pakistan about 27.8 million years ago. When it evolved, it diverged from Humulus (hops). There is evidence that cannabis was cultivated by humans 12,000 years ago, meaning that it has been cultivated by humans longer than any other plant. About 5000 years ago, cannabis spread throughout Eurasia. Ancient Chinese writings from 4,700 years ago, describe using cannabis to treat over 100 conditions.
From 1500-200 BCE, cannabis was used as a medicine in the Mediterranean region, Egypt, Greece, and India. Even the religious text of ancient Persia stated that cannabis was the most important of all medicinal plants. However, there was very little documentation of medicinal uses until the 17th century.
In the 1600’s, Robert Burton published The Anatomy of Melancholy. In this text he referenced hemp-seed as a useful antidepressant. Nicholas Culpeper further explored the use of hemp in The English Physician, where he concluded that it was also a potent anti-inflammatory. It is important to note that both refer to hemp which was commonly used for fiber in England. Hemp produced very high CBD:THC ratios.
In the 1800’s, William O’Shaughnessy studied medicinal cannabis use in India, where he had access to potent indica varieties. He not only experimented with treating various conditions but he also performed toxicity tests on animals. After determining the safety of cannabis, he identified anxiety, pain relief, and end of life care as indications for cannabis use. He stated, “Of all the powerful narcotics, it is the safest to use with boldness and decision”. He would then travel back to the west and reintroduce Indica strains to society.
In 1887, Raffaele Valieri compared the use of indica varieties to ruderalis. He used high CBD ruderalis and recommended inhaled hemp to treat neuropathic pain, Grave’s Disease, COPD, asthma, and migraine. In 1890, JR Reynolds, Queen Victoria’s personal physician, published that when treating pain, indica varieties were the most useful of drugs.
Finally in 1894, the first report of hemp and cannabis use was published. It was called The Indian Hemp Commission and consisted of 7 volumes, 3,291 pages, and 1,193 interviews. The report concluded that “it has been clearly established that the occasional use of hemp or cannabis in moderate doses may be beneficial to general health”.
It was not until 1925 when the League of Nations ratified the International Opium Convention which banned the use of cannabis except for medicinal or scientific uses. In 1928, the UK took it one step further and banned cannabis use completely. By the early 1930’s, it was banned in 48 states, despite remaining in the U.S. Pharmacopeia (USP) list of medicines.
In 1937, the U.S. Federal government passed the Marihuana Tax Act of 1937, which effectively banned cannabis use in America. At the hearing the American Medical Association (AMA) testified to not ban the medicinal use of this plant. Unfortunately, all physician’s testimonials were ignored. In fact, the AMA continued to oppose the removal of cannabis from the USP until it was finally removed in 1942.
From 1942-1960 the only research that was done on cannabis was for the purpose of identifying it as an illegal narcotic. Finally, in 1960, scientific research on cannabis began again and it launched the modern era of cannabis. Raphael Mechoulam would then isolate THC in 1964. For the first time in history, humans had identified the compound responsible for the controversial effects of cannabis. Mechoulam postulated that our bodies must produce its own cannabinoids, called endocannabinoids. He even predicted two of them which would later be proven to be true. The search for the receptors that THC acted on had begun, and would eventually lead to the discovery of the endocannabinoid system in 1989.
In 1996, the Compassionate Use Act of 1996 was passed in California. This was the first time a state had legalized the medicinal use of cannabis.
In 2016, the USP announced that cannabis is currently in the process of being added to the pharmacopeia.
There are about 120 phytocannabinoids in cannabis, however, only about 50 exist in significant quantities. Many of these exist as precursors or metabolites. For example, CBG leads to the synthesis of CBD, CBC and THC. Conversely, THC turns into CBN upon oxidation.
Cannabinoids are fat soluble molecules similar to omega 2 fatty acids. When they are first synthesized in the plant they are created in an acid version (i.e. THCA, CBDA, CBCA, CBGA). When heat is applied these molecules are decarboxylated and become neutral (i.e. THC, CBD, CBC, CBG). The process of decarboxylation is very important depending on what effects are desired. Cannabinoids can also be made in a propyl form (i.e. THCV, CBDV).
Each cannabinoid may offer unique effects that can be used to target specific symptoms. However, it is important to realize that no one cannabinoid is more important than another. They all offer benefits and may even work best synergistically. This is why there are various ratios of CBD:THC. Here is a list of some cannabinoids you may encounter:
- THC and THCA
- CBD and CBDA
- CBG and CBGA
- CBC and CBGA
- Delta8 THC
There are over 200 terpenes found in cannabis, however, only about 30 exist in significant quantities. Terpenes are responsible for all flavors and aromas in cannabis. They also can provide diverse medical benefits. Terpenes influence the entire experience by working synergistically with cannabinoids; we call this the entourage effect. Terpenes can be made in various forms. The terpenoid alcohols end in -ol. The terpenes end in -ene. Here are some terpenes you may encounter:
- Pinene (alpha, beta)
- Caryophyllene (beta)
- Humulene (alpha)
When Raphael Mechoulam isolated THC in 1964, he sparked the search for how THC works in the body. Researchers began looking for the receptor that THC binds to. Finally, in 1989, the first cannabinoid receptor was found and named as CB1. At the time, this receptor was part of a novel body system that nobody knew existed; the endocannabinoid system.
It was hypothesized that since humans already expressed these receptors, then the body must already make its own cannabinoids, called endocannabinoids (hence the name of the system). When someone consumes cannabis, cannabinoids from the plant, called phytocannabinoids, are able to bind to and interact in our endocannabinoid system. In fact, Mechoulam predicted 2 endocannabinoids (anandamide and 2-AG), which would later be discovered in 1992.
Since then, scientists have discovered that the endocannabinoid system developed when animals evolved into complex organisms. The most primitive species identified to have an endocannabinoid system is the sea-squirt and hydra which evolved some 600 million years ago. This ancient body system can be found in “mammals, birds, amphibians, fish, sea urchins, leeches, and mussels” but not insects. Scientists have also identified that the endocannabinoid system expresses more receptors than any other body system. This evidence shows that the endocannabinoid system plays a vital role in basic life form functioning.
Put simply, the endocannabinoid system is our body’s balancing act. It is a direct homeostatic system, responsible for regulating basic functions that are shared across the animal kingdom.
Routes of Administration / Methods of Consumption
Commitment to Providing Multiple Modes of Administration. Still River Wellness understands that patients may require specific types of products and devices in order to consume their medical marijuana. The dispensary is only interested in curating the most useful and innovative items available on the market.
- Onset in under 1 minute
- Peak in 30 minutes
- Duration 1.5-3 hours
- Easy to dose
- Onset in 60-90 minutes
- Peak in 2-3 hours
- Duration 6-8 hours
- Difficult to predict dosing
- Onset in 15-45 minutes
- Peak in 1-2 hours
- Duration 3-4 hours
- External use only
- Very little systemic absorption
- Potent local effects
Tolerance, T-breaks and Substance Abuse
Tolerance is when your body becomes less responsive to a substance. Your body can become tolerant to cannabis. The main sign that tolerance is building is when higher doses are required to achieve the same effect. In an effort to limit tolerance, it is recommended to use the minimal effective dose necessary. Fortunately, tolerance is reversible. In terms of cannabis use, tolerance can be regained by abstaining from cannabis use. In just 3 days of abstinence tolerance will begin to decrease. In 28 days, tolerance is almost completely gone.
All drugs have different physiological effects, however, the signs and symptoms of substance abuse and addiction are similar across the board. Some common signs/symptoms of substance abuse are:
- Neglecting responsibilities
- Using drugs under dangerous and illegal conditions
- Experiencing legal trouble
- Relationship problems
- Some common signs/symptoms of substance addiction are:
- Built significant tolerance
- You must use in order to avoid withdrawal symptoms
- Loss of control over drug use
- Life revolves around drug use
- You have abandoned activities you used to enjoy
- You continue to use despite recognizing the harm
If you recognize any of these signs or are experiencing any symptoms, seek help by reaching out to a dispensary pharmacist.